Financial Hardship Program

Footprints to Recovery’s Financial Hardship Program is designed to reduce patient costs for eligible patients with limited financial means. Footprints to Recovery offers the Financial Hardship Program to individuals who are unable to pay in full for services.

The company will not discriminate on the basis of ethnic group identification, religion, age, sex, color, gender, race, sexual orientation, or disability. Company’s sliding scale fee schedule is based on the Federal Poverty Guidelines.

To be considered for the Financial Hardship Program please fill out the below application in full. Upon receiving your application Footprints to Recovery’s financial specialists will review your information and contact you with further steps.

If you have any questions along the way, feel free to contact us

[mk_icon_box2 icon_size=”48″ icon=”mk-moon-phone-2″ icon_background_color=”#f5f5f5″ title=”Call” title_bottom_padding=”0″ read_more_url=”tel:855-628-2899″][/mk_icon_box2]

[mk_icon_box2 icon_size=”48″ icon=”mk-icon-envelope-square” icon_background_color=”#f5f5f5″ title=”Email” title_bottom_padding=”0″ read_more_url=”mailto:[email protected]”][/mk_icon_box2]

Financial Hardship Program Application

Please complete the following information to help us determine if you or members of your family are eligible for a percentage cost reduction. The percentage cost reduction will apply to all services received at this facility, but not to those services received outside the facility. This form must be completed every 12 months or if your financial situation changes.

 

  • Patient

  • Head of Household

  • Please list self, spouse and dependents under age 18.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Total Household Size (Number of Individuals Living in House)

  • Annual Household Income

  • Gross wages, salaries, tips, etc.

  • Income from business, self-employment, and dependents

  • Interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources

  • Unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income

  • Total Income

  • NOTE: Please include copies of tax returns, W2s, pay stubs, or any other information verifying income.
  • Drop files here or
  • Type Your Name to Sign

  • This field is for validation purposes and should be left unchanged.

Insurance

Your insurance may cover a portion or the bulk of treatment costs, which vary from person to person and depend on your specific policy. Footprints to Recovery accepts most major insurances and will work directly with your provider to get you the best coverage.

Verify Insurance Coverage »

Private Pay

For those who would rather not use their insurance or are only approved for coverage of a portion of treatment, we accept private pay at any of our facilities.

We offer flexible payment plan options if needed.

Financing

No insurance? Can’t do private pay? We have formed relationships with Prosper Healthcare, who offers special loan packages that are affordable and tailored to the cost of treatment. Through Prosper Healthcare you can apply for full or partial financing.

Prosper Healthcare »

Trusted & Approved Addiction Treatment Centers

Helo Icon

The National Association of Addiction Treatment Providers (NAATP) is a nonprofit professional society designed to offer support to organizations across the continuum of care. Since 1978, it has extended resources, advocacy and thought leadership to its members.

Helo Icon

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHCO) evaluates quality of care provided by healthcare organizations. Footprints has the Gold Seal of Approval, which means we possess the highest standard of safety and quality of care.

LegitScript is a third-party certification that confirms that Footprints follows all applicable laws and regulations. It shows that our company has been vetted and that we demonstrate an ongoing commitment to integrity and transparency.